Attention to Threats and Combat-Related Posttraumatic Stress Symptoms: Prospective Associations and Moderation by the Serotonin Transporter Gene
Open accessAbstract
IMPORTANCE: Combat places soldiers at risk for posttraumatic stress disorder (PTSD). The excessive rates of PTSD and other adjustment disorders in soldiers returning home make it imperative to identify risk and resilience factors that could be targeted by novel therapeutic treatments. OBJECTIVE: To investigate the interplay among attention to threat, combat exposure, and other risk factors for PTSD symptoms in soldiers deployed to combat. DESIGN AND SETTING: Longitudinal prospective study of Israeli Defense Force infantry soldiers carried out in 2008 through 2010. Repeated measurements during a 1-year period included baseline and predeployment data collected in training camps and deployment data collected in the combat theater. PARTICIPANTS: Infantry soldiers (1085 men; mean age, 18.8 years). MAIN OUTCOME MEASURES: Postcombat PTSD symptoms. RESULTS Soldiers developed threat vigilance during combat deployment, particularly when they were exposed to high-intensity combat, as indicated by faster response times to targets appearing at the location of threat relative to neutral stimuli (P < .001). Threat-related attention bias also interacted with combat exposure to predict risk for PTSD (P < .05). Bias toward threat at recruitment (P < .001) and bias away from threat just before deployment (P < .05) predicted postcombat PTSD symptoms. Moreover, these threat-related attention associations with PTSD were moderated by genetic and environmental factors, including serotonin transporter (5-HTTLPR) genotype. CONCLUSIONS AND RELEVANCE: Combat exposure interacts with threat-related attention to place soldiers at risk for PTSD, and interactions with other risk factors account for considerable variance in PTSD vulnerability. Understanding these associations informs research on novel attention bias modification techniques and prevention of PTSD.
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Longitudinal studies show associations between war exposure and attentional biases toward threat stimuli.
“These findings are also in line with longitudinal studies showing associations between war exposure and attentional biases toward threat stimuli (Wald et al., 2013).”
From Toward objective characterizations of suicide risk: A narrative review of laboratory-based cognitive and behavioral tasks (2023) · cites this paper as Wald et al., 2013
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- Authors
- Wald, I., Degnan, K. A., Gorodetsky, E., Charney, D. S., Fox, N. A., Fruchter, E., Goldman, D., Lubin, G., Pine, D. S., & Bar-Haim, Y.
- Affiliations
- Tel Aviv University (IL)
- National Institutes of Health (US)
- ORCID
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2013-04-01
- Volume
- 70
- Issue
- 4
- Pages
- 401
- ISSN
- 2168-622X (ISSN-L)
- PMC
- PMC4469781
- OpenAlex
- W2100998167
- Semantic Scholar
- c1a585eab292cd4d4a3c222a50f91f0d1c4f237c
- Cited by
- 125
- References
- 49
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 3 · 2023: 3 · 2022: 8 · 2021: 7 · 2020: 7 · 2019: 11 · 2018: 13 · 2017: 11 · 2016: 18 · 2015: 14 · 2014: 10 · 2013: 7 · 2012: 1
- FWCI
- 18.15
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (Z99 MH999999)
- National Institute of Mental Health
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- post-traumatic stress disorder, combat exposure, threat vigilance, military personnel, infantry soldiers, genetic risk factors, environmental risk factors, PTSD risk factors, attentional bias modification, PTSD prevention
- MeSH terms
- Adolescent, Attention, Genotype, Humans, Israel, Male, Military Personnel, Neuropsychological Tests, Prospective Studies, Risk, Stress Disorders, Post-Traumatic, Warfare, Serotonin Plasma Membrane Transport Proteins, Young Adult
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